AIDS: a good example of why science policy matters

Former South African President Thabo Mbeki rejected AIDS research and science …

AIDS is a serious problem for Africa. The least developed continent (obviously not counting Antarctica) on the planet has to deal with poor governance and crumbling infrastructure; add HIV/AIDS into the mix and the result is an extra 1.5 million deaths every year. That's a Rwandan genocide every eight months. That need not be the case, argues a study published in The Lancet. The study takes data gathered in South Africa and proposes an antiretroviral strategy that models suggest could almost wipe out HIV/AIDS transmission in a matter of decades.

HIV/AIDS has become something of a developing world disease. Science has developed treatments for the virus, but they're expensive. In nations that have a hard time paying for cheap drugs to fight malaria or leishmaniasis, paying for antiretrovirals can fall off the list.

But it's not just an issue of cost. South Africa is well off compared to its regional neighbors—it had enough money for the former President, Thabo Mbeki, to splash out nearly $100 million on a new Boeing Business Jet. Mbeki claimed poverty when it came to providing his citizens with antiretroviral drugs, however.

Worse yet, for a country facing such an immense AIDS epidemic (fueled in part by economic migration of men from across the continent looking for work), Mbeki rejected science when it came to formulating health policy. That policy didn't initially focus on controlling HIV, as South African officials gave credence to distortions promulgated by people like Peter Duesberg and Kary Mullis, who both claim that HIV doesn't cause AIDS (I do wonder how Mullis, a Nobel Laureate, reacted to this year's Nobel Prize for Medicine, which honored those who discovered HIV).

Mbeki also appointed a health minister, Manto Tshabalala-Msimang, who outraged health workers across the globe when she announced that a diet of African potatoes and garlic was all that AIDS patients needed to restore them to health. Perhaps that's to be expected of a health minister who was fired from several hospitals she used to manage for stealing from the patients' bedsides, and apparently celebrated her own liver transplant by getting drunk.

A an article published last month in the Journal of Acquired Immune Deficiency Syndromes (and followed up in today's New York Times) estimates that Mbeki's pseudoscientific platform has been responsible for 365,000 early deaths since 2000. This should serve as an abject lesson in why it's vital for governments to receive effective science and health policy advice.

Advice of this sort can be found in the online issue of The Lancet, which is running an article from the World Health Organization. The WHO proposes a strategy that could reduce the mortality from HIV/AIDS to 1 in 1000 within a decade, and the overall incidence of the disease to one percent within 50 years. The strategy revolves around universal testing, where adults would have an annual HIV test, combined with antiretroviral therapy for all who carry the virus.

According to mathematical models used by the authors, this strategy would shift the nature of the epidemic away from constant fresh infections throughout the populace. As mortality declined, at-risk populations could then be targeted more effectively.

Of course, this plan wouldn't exactly be cheap, as cost estimates are around $40-50 billion for a decade. But $10 billion was spent on AIDS in Africa in 2007, so the plan would save money in the long run as expenditures begin to decline when the epidemic subsides. Furthermore, the costs of inaction through lost productivity, early mortality, and continued economic deprivation would far outweigh that sum.